First ask yourself, “What am I bringing to the patient encounter?”

• Reflect on your own biases and preconceived notions. 
• Consider how your biases or identities may impact your clinical care of patients, particularly BIPOC patients. 
• Engage in racial identity development work. There are many frameworks in which to do this, and the journey will look different depending on what racial group you belong to. Commit to evolving your understanding and integration of your racial identity. Remember, this work is lifelong and non-linear. 

Consider what the patient is bringing to the interaction.  

BIPOC patients are more likely to report negative medical experiences, especially those mediated by discrimination

There are a few things to keep in mind when meeting a patient, especially if the patient has previously experienced discriminatory or traumatic care.

• Rapport building takes time. When possible, continuity of care is preferred to allow for a partnership to develop. 
• Make sure you are not making assumptions, avoiding tough questions, or skipping straight to recommendations without first hearing the patient’s point of view. 
• Always remember to actively listen. Patients can tell, and it will help you collect the information you need to make well informed and culturally relevant medical recommendations.

When first meeting a patient, ask, “Is there anything you’d like me to know about past medical experiences?”

This question may elicit a variety of responses from a simple “no” to detailed accounts of past medical trauma. Regardless of the answer, keep a few things in mind: 

• It’s important to give time for patients to answer. This can feel at odds with the time-pressured visits common in most medical settings, however, it will allow for better rapport, better treatment adherence, and a lower chance of repeating previous harms.
• You don’t have to fix it, and you likely can’t. Asking the question, validating whatever emotions they share, and doing your best to not repeat the same mistakes is where to start. 
• Get permission to document the response in their chart. Asking permission helps build a partnership with the patient and documentation allows other clinicians to be aware without expecting the patient to retell their story.

Learn about the communities your patients are coming from. 

Healthcare doesn’t occur in an exam room bubble. Patients spend more time in their communities than they do during your encounter. By learning more about where your patients live, work, and socialize you can give more informed and relevant recommendations. 

This is especially important for your BIPOC patients who disproportionately make up neighborhoods with higher rates of policing, environmental pollutants, and food apartheid. 

Engage in, donate to, and learn from BIPOC community organizers. They will have the best insights into the health needs and concerns of their community. This can guide you in making sure your clinic’s referrals and internal resources align with the realities of the community in which it is situated. 

Honor the desire for race concordant care. 

Some, not all, BIPOC patients may prefer receiving care from someone who shares racial, ethnic, or other cultural similarities. 

• Research indicates that racial concordance between a patient and a clinician is associated with several positives. 
• Better patient-provider communication
• Improved overall health outcomes
• Higher levels of patient satisfaction
• More adherence to provider recommendations‍

• If you are in a position to do so, advocate for the hiring of BIPOC health care workers. Whenever possible, advocate for the dismantling of racist workplace structures that can lead to quicker BIPOC provider and staff burnout. 
• Ask patients if they have any preferences in the identity of their healthcare providers, including race, ethnicity, sexuality, language, and gender identity. 
• Advocate for visibility of these identities on patient-facing information about the providers at your clinical practice, and, when possible, your referrals.
• Providing race concordant care may not always be possible as the majority of mental health treatment providers in the United States are white. For example, approximately 86% of psychologists are white, and less than 2% of American Psychological Association members are Black.
• When providing cross-racial care, be humble in your integration of racially informed care. 

Practice through an intersectional lens. 

• Utilizing an intersectional approach allows us to acknowledge that a patient’s overlapping identities create unique modes of advantage and oppression.
• Consider what identities you hold and what your intersections of privilege or disadvantage are. 
• We should lead with dismantling racism—never to the exclusion of other ‘isms (e.g. sexism, classism). We should always consider how these various forms of oppression layer on top of each other to cause harm to individuals and communities.

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